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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# w'l &✓+c� <br /> BUILDING PLANNING <br /> Intake OK by: Date: <br /> Intake OK by:.. v-Y Assign To 7 ' Date (D a2i1 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building Attach to Project No. <br /> ❑ Route to Residential Building ❑foute to Historic Reviewer <br /> ❑ Make this a"W" Permit OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Za ' zone <br /> 'L'. <br /> Number of Stories Overlay/Agreement <br /> Basement �No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction \RC. Residential Use � 'DU <br /> Occupancy Group \'� . Proposed No.of Dwelling Units: <br /> Occupancy Load \g-� Total No.of Dwelling Units: Z, <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ®Not Req'd School Impact Fee: Total <br /> Reason Fire Alarm Required: Ca lated: ICU SC4't L I IM r�dit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br /> a erett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ®No Additional Notes: <br /> VALUATION CALCULATION: Total$ � , 1oS <br /> C-2) �•4g� = 3ao�co <br /> / q/ 5 /ç <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed If: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> _€❑Site Work or Drainage Proposed <br /> Approved By: 6�T Date: tp �� ¢d2� ❑Backflow Prevention for high hazard: <br /> `(dental,medical,animals,mortuary,hospital, <br /> =supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AN ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: L A Separate PW Permit is Required(Permit#: PW2.107-073 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND OQ Is located in this folder <br /> /] Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> O Review/Inspection Sc e-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: J - I.L, Date: CI 13/?/1 El Public Works has no scope---PW Not Required <br /> I f " Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: 1, Ch (� <br />